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Arizona rates for HCPCS J1572

Injection, immune globulin, (Flebogamma/Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.37 / $94.17 / $190.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.46 / $61.75 / $105.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.75 / $188.89 / $299.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.94 / $50.82 / $336.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.40 / $63.50 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $59.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $52.94